Archived: Sunnyview

Sunnyview is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sunnyview is situated in Ferrybridge, with easy access to local facilities. The home provides services for up to seven individuals with learning disabilities and associated mental health needs. The home is on two floors, and each person has their own room. There is an enclosed garden, which people in the home can access. At the time of our inspection there were six people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen

There was a registered manager in post, who had been recruited since our last inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe at Sunnyview, and we saw the registered manager checked this was the case at regular service user meetings. Staff training and the provider’s processes meant people were well safeguarded, and we saw the registered manager investigated and reported any incidents appropriately. There were enough staff on duty to enable people to receive support when they needed it, and we saw records which showed staff had been recruited safely. We saw evidence of a good approach to equality of opportunity in recruitment practices.

People lived in a clean and well-maintained home, and we saw the registered manager ensured regular servicing of safety equipment.

Medicines were well managed. Stocks and records were up to date, and we saw documentation in place which supported good practice in this area. Staff responsible for administering medicines had regular training and observation of their practice.

Staff were well supported to be effective in their roles. They had access to appropriate training which was regularly updated, and attended supervision meetings to discuss their performance. People were supported to have good access to health and social care professionals, and there was accessible documentation in place to help people with appointments.

Care plans showed how people made decisions and how and when they may need support. Appropriate safeguards were in place where people could not make decisions, for example about where they lived. Independent advocates were involved in supporting people with their decision making.

We saw people could make choices about how they spent their time, and were able to have regular access to the community. People’s diet was tailored to their preferences and needs, and we saw healthier eating was promoted.

People told us they got on well with staff, and we observed this was the case. Care and support were provided in caring ways, and people were able to contribute to decisions about their care when they wished to. Care plans were person-centred and detailed, meaning staff had access to information about how each person wished to received care. People had access to a range of activities which they were supported to plan. People told us they would know how to complain if they needed to, and we saw there were systems in place to ensure complaints were responded to appropriately.

Care plans were detailed, kept under review and incorporated advice and guidance given by other health professionals. There was a focus on achieving positive outcomes for people and how this could be done. Care plans for end of life care were in the process of being rewritten.

We found there was good leadership in the service. The registered manager had driven significant improvements for people and staff, and was passionate about providing excellence in care. There were strong systems in place to monitor and improve quality in the service, and where incidents occurred there were robust systems in place to ensure any potential lessons that could be learnt were captured and acted upon.

People who used the service were encouraged to influence the service in meaningful ways, and we saw there was a very high commitment to equality of opportunity: the registered manager listened to and acted on suggestions from people and staff, and we received excellent feedback about their ability to provide outstanding care and leadership. Staff were well motivated and empowered and other health and social care professionals praised the service.

Sunnyview was last inspected in December 2015 and was rated as ‘good’ overall, with ‘outstanding’ in the responsive domain. This inspection was prompted in part by notification of an incident following which a person who used the service sustained a serious injury. This incident may be subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

The information received by the Care Quality Commission (CQC) about the incident indicated potential concerns about the way the service managed risk to people. This inspection included an examination of those risks.

At the time of our inspection, six people were being supported at the home; one person was in hospital.

The home did not have a registered manager. The last registered manager left in December 2015. A new home manager had been appointed and was about to apply to be registered at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Most risks to people had been managed properly, however, we noted the risk assessments and care and support plans of some people with identified risks did not include the information staff needed to manage these risks. Most checks on the building and utilities were up to date; however, we found electrical hazards identified in December 2015 had not been addressed for over 11 months.

We observed medicines administration was person-centred. Documentation relating to medicines management was not always correct and there had been persistent issues in 2016 with medicine stock-checking and reconciliation.

Support workers and one relative told us there had been issues with low staffing levels, particularly at weekends. The home manager acknowledged this but said the registered provider was making efforts to recruit more staff. People we spoke with at Sunnyview said there were enough staff.

Most aspects of recruitment were done correctly, although records showed one support worker had not provided a full employment history, as is required by the regulations.

Staff could describe the different forms of abuse people living at Sunnyview might be at risk of. They said they would report any concerns to managers or the local authority safeguarding team.

Incidents and accidents which had occurred at the service since the last inspection had been managed, investigated and documented correctly. We saw evidence they had been followed up by the home manager.

We found the home was clean and tidy.

Most staff had received the training they needed to meet people’s needs, although identified some gaps. Support workers had access to supervision, however, this had not been according to the registered provider’s policy of six per year in 2016. The registered provider was reviewing their appraisal policy at the time of the inspection.

The service was compliant with most aspects of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although we noted people’s families had not been involved in best interest decision-making on their relatives’ behalf.

People were happy with the meals they were provided with at Sunnyview and told us they could choose foods they liked. Support workers encouraged people to eat a healthy diet.

Records showed and people told us they were supported by the service to maintain their general health.

Detailed records were kept when support workers used physical restraint to help people experiencing behaviours which may challenge others. Staff had received the training they needed to do this safely.

People and their relatives told us staff were caring and respected people’s privacy and dignity. We saw support workers encouraged people to maintain and increase their independence.

The service tried to involve people in designing their own care and support plans. People had access to independent advocates when they needed them.

People had detailed assessments of their needs, personal histories and support plans to guide staff to help meet those needs. We found issues with how information from other healthcare professionals had been incorporated into people’s care and support plans and stored.

People’s care files included no information about their future plans, goals or aspirations. Their ‘circle of support’ plans did not include their friends and families.

A comprehensive transition plan had been developed and implemented for a person who came to Sunnyview shortly before the inspection from another long term placement. Some people’s hospital passports were either blank or lacked detail.

People told us they had enough activities to keep them busy and they could choose what they wanted to do. They also had the opportunity to go on holiday every year if they wanted to.

No complaints had been received by the service since the last inspection. People and relatives said they felt able to complain if they needed to. There was an open and positive culture at the home.

The home manager lacked oversight of various aspects of the service. Services have a legal duty to inform CQC about certain events or incidents that occur, for example, when abuse is suspected. The manager had not notified us about four such occasions in 2016. We recommended the registered provider ensures appropriate support and training is provided to the home manager so they can develop the skills and knowledge they need to become the registered manager.

People had opportunities to feedback about the service at regular house meetings. Staff at the home had regular team meetings. The registered provider had surveyed people, their relatives and staff in 2016 and were in the process of disseminating the results.

Support workers understood the visions and values of the service. They enjoyed their roles and said working with the people at Sunnyview gave them job satisfaction.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Sunnyview provides accommodation and personal care for up to 7 younger adults with a learning disability, autistic spectrum disorder and associated complex needs. All the people who use the service require bespoke and flexible support packages. There were five people living at the service on the day of our inspection.

Sunnyview is a large house in a quiet residential area which offers accommodation over two floors. There is a quiet ‘bungalow’ at one end of the service with a dedicated summer house in the garden which was built to meet the specific needs of one person who uses the service. The other people who use the service live together in the main house, where they have their own rooms which are highly personalised with décor and personal effects of their choice.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a manager registered with the Care Quality Commission (CQC); they had been registered since December 2010. At the last inspection on 4 November 2013, the registered provider was compliant with all the regulations we assessed.

The registered manager and staff team demonstrated an in-depth understanding of managing risk and supporting people that had historically displayed behaviour that challenged others to live as independently and safely as possible. The staff team utilised risk management strategies effectively and were able to support people to try new things and make positive changes to their lives.

Within the main house, there were quiet spaces. These allowed people to be around each other without having to be in the same room. This encouraged one person in particular to spend time in the main part of the home. They would not have been able to do this without their own space being available to them. There is a kitchen, two lounges, two dining areas, a bathroom and toilets all of which are shared.

There is open access to the garden area. This has a summer house so people living in the main house who smoke can do so without having to endure poor weather conditions and is an additional quiet area. People who use the service have access to groups and social events which are arranged by the provider within the group of services they have in the area. This allows people who use services to expand their circle of friends, to access educational classes which allow them to explore and develop new skills and to attend social events with people from other homes within the local area.

There was very clear evidence of the time and effort which was spent developing and continuously improving the service. The provider and their senior management team came up with innovative and flexible ways to support people to move forward. The staff team looked at the barriers which were stopping people achieving their goals and found ways to remove those barriers without increasing the risk to the person who used the service or other people.

The registered provider was constantly reviewing, improving and where needed adapting the environment to meet people’s needs and to ensure that any new people who were admitted to the service had a suitable environment from the moment they arrived, adaptations were also made for the changing needs of people who were already using the service.

We found that each person had a personalised programme of activities which were designed in partnership with the people who used the service, focussing on their particular interests and current goals. The staffing of the service enabled people to learn to live as independently as they were able and to ensure that they led meaningful, enriched lives, with clear goals and plans of how they were going to work to reach them, which were realistic and achievable.

Staff were passionate and highly skilled, ensuring that people were safe whilst encouraging them to embrace new experiences and to explore and develop their abilities. The registered manager and the staff team worked with drive and commitment to provide the best care possible, identifying and sharing people’s personal achievements with their peers across the group and celebrating and commending successes.

The culture in the home was extremely person-centred, with the people who used the service being the focus at all times. Person centred care was tailored around the individual needs of each person, incorporating their aspirations, values, preferences and wishes. Care records showed that people’s individual needs were very regularly reviewed with the person who used the service being central to this process; we saw that care plans were evolving as people developed and progressed.

Staff worked exceptionally well together as a team, and all the staff we spoke with demonstrated their passion for making a difference to people’s lives and helping them to achieve their potential. Staff were unanimous in telling us that the registered manager was a strong leader, who was highly visible in the service.

Some people who used the service had complex needs and were not able to communicate their experiences to us verbally. We observed their interactions with staff and other people who used the service, to give us an insight of their needs, that the care they received was in line with that described in their care plans and that their needs were being fully met. We saw that staff treated people kindly, empathetically, with respect and dignity and it was clear they knew people and understood their needs extremely well and that people’s needs were fully met as a result.

We saw staff were safely recruited and that all necessary checks were carried out before they started work and that new staff went through a detailed, comprehensive induction process. There was a ratio of one to one staff to people who used the service at all times, which meant that there were always enough staff to meet people’s needs safely and for people to be engaged in positive activities which enriched their lives.

Staff received training and support to ensure that they had the skills and knowledge necessary to support people who used the service, there was an extensive range of specialist training available to staff in addition to mandatory training. Training was classroom based and included best practice information and guidance. Staff told us they found their training to be ‘excellent’ and they felt confident in their own competence as a result of this.

Medicines were ordered, stored, administered and disposed of safely. Personalised support plans were in place to ensure people received their medicines in line with the prescriber’s instruction and their own preferences. There were plans in place and work underway to help a person who had strongly expressed that they wanted to be able to manage their own medication to achieve this safely over a period of time.

People accessed community based facilities which had been sought out to meet their needs. People also completed varied and fulfilling activities within the service. People were actively encouraged to develop social interests, were supported to develop friendships, develop and maintain family relationships and were encouraged to be active and healthy.

People’s records showed their nutrition and hydration needs were well met. There were choices offered at every meal. People had access to a range of health professionals for advice, support and where needed treatment.

There was clear guidance for staff to help them reduce or eliminate behaviour that challenges others. We saw the use of positive behaviour management principles which identify triggers for behaviour which challenges others.

People enjoyed a safe environment which whilst it had been designed to meet the needs of people who used the service, looked and felt like a family home, where people were relaxed and well cared for.

We spoke with three people who used the service. They all told us they liked living at the home. One person told us they 'like my holidays, they take me on' and another person told us they 'like the staff.'

We spoke with four members of staff. They all told us they enjoyed working at the home. One staff member felt it was a 'lovely place to work, we get treated well.'

The staff we spoke with had a good understanding of the need to treat people with dignity and respect, for example they told us they would ensure bathroom doors are closed when people are using them and they would not enter a bedroom without the consent of the person.

We saw that staff had training in safeguarding and were able to tell us what they would do if they had any concerns about the people who used the service. The people who used the service told us they would talk to the manager if they had any worries about the way they were being treated.

We looked at the care plans of three of the people who used the service. We saw that they were centered around the needs of the individual and were reviewed and updated on a regular basis.

The staff we spoke with told us they had regular supervision. We looked at the supervision notes of two staff members and an annual review of one staff member. We saw that they were up to date and had been signed by all parties.

The home had an up to date medicines policy and we saw evidence that medications were administered safely.